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General NPI Number Information
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NPI Number | 1053083295
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Entity Type | Individual
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Provider Name | FAWAZ HATEM BDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 11540 15TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98125-6322
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Country | US
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Telephone | 206-440-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 3608 231ST PL SE
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City | BOTHELL
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State | WA
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Zip | 98021-6214
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Country | US
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Telephone | 509-539-6475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 125Q00000X
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Taxonomy Name | Oral Medicine Dentistry
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License Number | DENT.DE.61153474
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE.61153474
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License Number State | WA
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